312 Opioid-Analgesics

Opioid Agonist Prototype

Morphine-Sulfate

Opioid Agonist/Antagonist Prototype

Butorphanol

Opioid Antagonist Prototype

Naloxone (Narcan)

Opioid Routes of Administration

IV, SL, SQ, IM, PO, Nasal Spray

Morphine: slow IV push

Morphine Therapeutic Uses

* the management of chronic, moderate to severe pain
* acute coronary syndrome & anginal pain

Morphine Actions

* relieves pain
* dilates coronary arteries
* increases oxygenation
* increases perfusion
* **slows heart rate**
* **decreases blood pressure**

Morphine Half Life

2-3 hours

Morphine Adverse Effects

Overdose

* respiratory depression
* drowsiness
* skeletal muscle flaccidity
* cold & clammy skin

Can progress to

* pulmonary edema
* bradycardia
* hypotension
* cardiac arrest
* death

Morphine treatment of overdose

* oxygen
* vasopressors
* **antidote: naloxone**

Morphine Contraindications

* avoid alcohol or other CNS depressants
* use cautiously in renal and hepatic impaired clients

Morphine Nursing Assessment

Monitor for

* respiratory depression
* hypotension
* tachycardia
* oxygen saturation
* vital signs
* level of consciousness
* pain
* renal & hepatic function

Long term

* physical dependence
* addiction disorder
* drug abuse

Butorphanol Therapeutic Uses

a **synthetic** morphinan analgesic with narcotic antagonist action. used in the management of moderate to severe pain

Butorphanol Action

* act on the same pain receptors in the CNS as morphine and other opiates
* interfere with pain transmission and/or pain sensation

Butorphanol Adverse Effects

* headache
* dizziness
* drowsiness
* vertigo
* nausea, vomiting, constipation
* hallucinations
* euphoria

Serious symptoms

* hypoventilation
* cardiovascular insufficiency
* coma
* death

Butorphanol Contraindications

* low BP (systolic of 90 or lower)
* respiratory distress/failure

Nalaxone Therapeutic Uses

Primary use is to relieve opioid-induced CNS and respiratory depression; rapidly reverse an opioid overdose

* therapeutic effects occur rapidly
* IV: about 2 minutes
* IM: 2-5 minutes
* SQ: 2-minutes
* Intranasal: 8-13 minutes

Nalaxone Action

competitive inhibitor that antagonizes the actions of opioids in the brain, reversing their effects

Nalaxone Adverse Effects

associated with very few side effects, only opioid withdrawal symptoms such as

* nausea/vomiting/diarrhea
* sweating
* runny nose
* aches

Naloxone Contraindications

avoid alcohol or other CNS depressants

Naloxone Nursing Assessment

* short duration of action so multiple doses may be required
* has no effect if a patient has not taken opioids
* monitor for respiratory depression, hypotension,, tachycardia, and O2 sat when the drug wears off
* continuously monitor vitals and LOC